基于Pinnacle3自动化计划设计模块在直肠癌调强放疗的应用研究  

A dosimetric study of automated intensity-modulated radiotherapy planning for rectal cancer patients based on Pinnacle3 system

作　　者：王继平[1] 杨志勇[1] 陈传喜[1] 王骁踊[2] Wang Jiping;Yang Zhiyong;Chen Chuanxi;Wang Xiaoyong(Department of Radiation and Medical Oncology,Central Hospital of Huanggang,Huanggang 438000,China;Department of Radiation and Medical Oncology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]湖北省黄冈市中心医院放疗科,黄冈438000 [2]武汉大学中南医院肿瘤放化疗科,430071

出　　处：《中华放射医学与防护杂志》2019年第4期285-289,共5页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的通过比较自动化计划设计(Auto-Planning, AP)和调强放疗(IMRT)在直肠癌调强计划设计中的靶区和危及器官的剂量学差异,探讨AP在直肠癌计划设计中的优势。方法选取10例直肠癌术后放疗病例,用Pinnacle3 9.10计划系统基于同一CT图像进行IMRT和AP计划设计,比较两种不同计划的剂量体积直方图,分析靶区适形度指数(CI)、均匀性指数(HI)和危及器官受照剂量的差异。结果AP计划中,靶区Dmean和Dmin略有增加,DmaxcGy略有减小,差异有统计学意义(t=-1.36、-3.03、0.37,P<0.05)。D2、D95、D98差异均无统计学意义(P>0.05)。AP计划中靶区的HI值有所降低,CI值有所提高,差异有统计学意义(t=1.24、0.10,P<0.05)。危及器官中膀胱V40、V50,小肠的V30、V45、V50,左右股骨头V30、V40,在AP计划与IMRT计划比较中差异有统计学意义(t=-3.21~1.02,P<0.05)。膀胱V30、V45,小肠V40及左右股骨头V45受照剂量体积均略低于IMRT计划,但差异无统计学意义(P>0.05)。结论直肠癌AP计划能够达到比IMRT计划更好的靶区适形度,能有效降低靶区最高剂量,增加靶区最低剂量,减少热点和冷点,同时降低危及器官受照剂量,更好的保护正常组织。Objective To compare the dosimetric differences of the targets and the OARs in rectal cancer patients between Auto-planning and intensity-modulated radiotherapy (IMRT), and explore the advantages of Auto-planning (AP). Methods A total of 10 postoperative radiotherapy rectal cancer patients were selected, whose CT images were used to create AP plan and IMRT plan respectively using Pinnacle3 9.10 treatment planning system. Through comparing the dose-volume histograms of the two plan types, the differences of the homogeneity index, conformity index and the doses to organs at risk (OARs) were analyzed. Results The AP plans were significantly better (t=-1.36,-3.03, 0.37, P<0.05) in terms of higher Dmean, Dmin and lower Dmax. But the differences in D2, D95, D98 were insignificant (P>0.05). In the AP plan, the HI values of the target area were significantly reduced, and the CI values were significantly increased (t=1.24, 0.10, P<0.05). Significant superior results were found in V40, V50of bladder, V30, V45, V50 of small intestine, V30, V40 of left and right femoral head (t=-3.21-1.02, P<0.05). AP plans achieved insignificantly lower V30, V45 in bladder, V40 in small intestine and V45 in left and right femoral head than IMRT plan (P>0.05). Conclusions Compare with IMRT plans, the AP plans for rectal cancer can achieve better homogeneity index, effectively reduce the maximum dose, increase the minimum dose, reduce hot and cold volumes in the target area. Meanwhile, AP plans can also protect the normal tissues better by reducing the dose to the OARs.

关 键 词：直肠癌 自动化计划设计 调强放射治疗 

分 类 号：R730.55[医药卫生—肿瘤]